Maternal, Newborn And Child Health Research Articles

Facilitators and barriers to supply-side maternal, newborn, and child health service availability in DRC: a systematic review and narrative synthesis

Background This study is a systematic review of barriers and facilitators of supply-side maternal, newborn, and child health (MNCH) service availability in the Democratic Republic of the Congo (DRC). Given gaps in understanding of the factors affecting supply-side service availability, authors reviewed the literature to describe the DRC’s landscape and inform future research and programming. # Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, authors searched two databases and grey literature, using the Quality Assessment with Diverse Studies tool to assess quality. Authors identified key themes and used a narrative approach to analyze extracted data. # Results The search identified 2160 articles, with 26 meeting the inclusion criteria. Authors grouped them according to the following key themes: facility readiness, human resources for health (HRH), geography and transportation, conflict, financing, and governance. MNCH service availability was hindered by lack of supplies, logistical challenges, weak infrastructure, unmet staffing needs, HRH turnover, poor HRH distribution, career and payment obstacles, long distances to facilities and poor transportation, system strain and disruption due to conflict, low government expenditure, high out of pocket costs, fragmented stakeholders, and low government prioritization. Authors found facilitating factors in each key theme, including parallel supply chains and buffer stocks, proactive staffing policies, motivated HRH, novel transportation methods, health posts, concentrations of stakeholders in conflict zones, universal health coverage policies, provider payment reforms, stakeholder coordination, and horizontal integration efforts. # Conclusions The DRC faces substantial supply-side barriers to MNCH service availability. Progress towards the Sustainable Development Goals and better MNCH outcomes requires additional work to build on existing facilitators and investments in service availability. Additional research on demand-side factors and quality of care could inform these efforts.

A Comparative Analysis of Healthcare Facilities: With and Without 24/7 Interventions.

Background: Maternal and neonatal mortality remains disproportionately high in low and middle-income countries, particularly in remote areas with limited healthcare accessibility. The Tharparkar district of Sindh, Pakistan, exemplifies such challenges, with basic utilities and healthcare services notably lacking. Objective: This study aimed to assess the impact of 24/7 availability of Maternal, Newborn, and Child Health (MNCH) services on healthcare delivery and patient outcomes in government healthcare facilities in the Tharparkar district. Methods: This action research followed a cross-sectional study design. Data collection commenced after receiving ethical approval and written consent from the Government District Health Officer of Tharparkar. Longitudinal data were collected using District Health Information tools from six healthcare facilities, three of which operated 24/7 and the remaining three for six hours daily. Data included indicators such as general outpatient department (OPD) visits, non-vaginal deliveries (NVD), antenatal, postnatal care, family planning, immunization, neonatal deaths, stillbirths, and live births. Statistical analysis was conducted using SPSS version 25, and results were visualized using Tableau 2024. Results: Facilities operating 24/7 reported a significant increase in healthcare utilization: general OPD attendance increased by 118.5% at THQ Kheeme Jo Par, 168.2% at GD Jese Jo Par, and 150.5% at GD Mehrna Vero. There were also notable improvements in NVD, antenatal, postnatal care, and family planning services. Immunization rates improved, stillbirths decreased, and there were zero neonatal deaths reported in these facilities following the intervention. Conclusion: The implementation of 24/7 MNCH services in Tharparkar significantly enhanced healthcare service delivery and improved maternal and child health outcomes. Continuous healthcare availability is crucial for improving health indicators and achieving global health targets in underserved populations.

Exploring the implementation of an SMS-based digital health tool on maternal and infant health in informal settlements

BackgroundThe rapid urbanization of Kenya has led to an increase in the growth of informal settlements. There are challenges with access to maternal, newborn, and child health (MNCH) services and higher maternal mortality rates in settlements. The Kuboresha Afya Mitaani (KAM) study aimed to improve access to MNCH services. We evaluate one component of the KAM study, PROMPTS (Promoting Mothers through Pregnancy and Postpartum), an innovative digital health intervention aimed at improving MNCH outcomes. PROMPTS is a two-way AI-enabled SMS-based platform that sends messages to pregnant and postnatal mothers based on pregnancy stage, and connects mothers with a clinical help desk to respond and refer urgent cases in minutes.MethodsPROMPTS was rolled out in informal settlements in Mathare and Kawangware in Nairobi County. The study adopted a pre-post intervention design, comparing baseline and endline population outcomes (1,416 participants, Baseline = 678, Endline = 738). To further explore PROMPTS's effect, outcomes were compared between endline participants enrolled and not enrolled in PROMPTS (738 participants). Outcomes related to antenatal (ANC) and postnatal (PNC) service uptake and knowledge were assessed using univariate and multivariate linear and logistic regression.ResultsBetween baseline and enldine, mothers were 1.85 times more likely to report their babies and 1.88 times more likely to report themselves being checked by a provider post-delivery. There were improvements in moms and babies receiving care on time. 45% of the 738 endline participants were enrolled in the PROMPTS program, with 87% of these participants sending at least one message to the system. Enrolled mothers were 2.28 times more likely to report completing four or more ANC visits relative to unenrolled mothers. Similarly, enrolled mothers were 4.20 times more likely to report their babies and 1.52 times more likely to report themselves being checked by a provider post-delivery compared to unenrolled mothers.ConclusionsThis research demonstrates that a digital health tool can be used to improve care-seeking and knowledge levels among pregnant and postnatal women in informal settlements. Additional research is needed to refine and target solutions amongst those that were less likely to enroll in PROMPTS and to further drive improved MNCH outcomes amongst this population.

Inter-district and Wealth-related Inequalities in Maternal and Child Health Service Coverage and Child Mortality within Addis Ababa City.

In sub-Saharan Africa, urban areas generally have better access to and use of maternal, newborn, and child health (MNCH) services than rural areas, but previous research indicates that there are significant intra-urban disparities. This study aims to investigate temporal trends and geographic differences in maternal, newborn, and child health service utilization between Addis Ababa's poorest and richest districts and households. A World Bank district-based poverty index was used to classify districts into the top 60% (non-poor) and bottom 40% (poor), and wealth index data from the Ethiopian Demographic and Health Survey (EDHS) was used to classify households into the top 60% (non-poor) and bottom 40% (poor). Essential maternal, newborn, and child health service coverage was estimated from routine health facility data for 2019-2021, and five rounds of the EDHS (2000-2019) were used to estimate child mortality. The results showed that service coverage was substantially higher in the top 60% than in the bottom 40% of districts. Coverage of four antenatal care visits, skill birth attendance, and postnatal care all exceeded 90% in the non-poor districts but only ranged from 54 to 67% in the poor districts. Inter-district inequalities were less pronounced for childhood vaccinations, with over 90% coverage levels across all districts. Inter-district inequalities in mortality rates were considerable. The neonatal mortality rate was nearly twice as high in the bottom 40% of households' as in the top 60% of households. Similarly, the under-5 mortality rate was three times higher in the bottom 40% compared to the top 60% of households. The substantial inequalities in MNCH service utilization and child mortality in Addis Ababa highlight the need for greater focus on the city's women and children living in the poorest households and districts in maternal, newborn, and child health programs.

Has the Gratuité policy reduced inequities in geographic access to antenatal care in Burkina Faso? Evidence from facility-based data from 2014 to 2022.

Evidence shows that user fee exemption policies improve the use of maternal, newborn, and child health (MNCH) services. However, addressing the cost of care is only one barrier to accessing MNCH services. Poor geographic accessibility relating to distance is another. Our objective in this study was to assess the effect of a user fee exemption policy in Burkina Faso (Gratuité) on antenatal care (ANC) use, considering distance to health facilities. We conducted a cross-sectional study with sub-analysis by intervention period to compare utilization of ANC services (outcome of interest) in pregnant women who used the service in the context of the Gratuité user fee exemption policy and those who did not, in Manga district, Burkina Faso. Dependent variables included were socio-demographic characteristics, obstetric history, and distance to the lower-level health facility (known as Centre de Santé et Promotion Sociale) in which care was sort. Univariate, bivariate, and multivariate analyses were performed across the entire population, within those who used ANC before the policy and after its inception. For women who used services before the Gratuité policy was introduced, those living 5-9 km were almost twice (OR = 1.94; 95% CI: 1.17-3.21) more likely to have their first ANC visit (ANC1) in the first trimester compared to those living <5 km of the nearest health facility. After the policy was introduced, women living 5-9 km and >10 km from the nearest facility were almost twice (OR = 1.86; 95% CI: 1.14-3.05) and over twice (OR = 2.04; 95% CI: 1.20-3.48) more likely respectively to use ANC1 in the first trimester compared to those living within 5 km of the nearest health facility. Also, women living over 10 km from the nearest facility were 1.29 times (OR = 1.29; 95% CI: 1.00-1.66) more likely to have 4+ ANC than those living less than 5 km from the nearest health facility. Insofar as the financial barrier to ANC has been lifted and the geographical barrier reduced for the populations that live farther away from services through the Gratuité policy, then the Burkinabé government must make efforts to sustain the policy and ensure that benefits of the policy reach the targeted and its gains maximized.

A Low-Cost, Integrated Immunization, Health, and Nutrition Intervention in Conflict Settings in Pakistan-The Impact on Zero-Dose Children and Polio Coverage.

Pakistan is one of two countries globally still endemic for poliovirus. While increasing immunization coverage is a concern, providing equitable access to care is also a priority, especially for conflict-affected populations. Recognizing these challenges, Naunehal, an integrated model of maternal, newborn, and child health (MNCH), immunization, and nutrition services delivered through community mobilization, mobile outreach, and private-sector engagement was implemented in conflict-affected union councils (UCs) with high poliovirus transmission, including Kharotabad 1(Quetta, Balochistan) and Bakhmal Ahmedzai (Lakki Marwat, Khyber Pakhtunkhwa). A quasi-experimental pre-post-design was used to assess the impact of the interventions implemented between April 2021 and April 2022, with a baseline and an endline survey. For each of the intervention UCs, a separate, matched-control UC was identified. At endline, the proportion of fully immunized children increased significantly from 27.5% to 51.0% in intervention UCs with a difference-in-difference (DiD) estimate of 13.6%. The proportion of zero-dose children and non-recipients of routine immunization (NR-RI) children decreased from 31.6% to 0.9% and from 31.9% to 3.4%, respectively, with a significant decrease in the latter group. Scaling up and assessing the adoption and feasibility of integrated interventions to improve immunization coverage can inform policymakers of the viability of such services in such contexts.

Applying the principles for digital development to improve maternal and child health in the Peri-urban areas of Karachi, Pakistan.

Low- middle-income countries, including Pakistan, are facing significant obstacles in their efforts to achieve the global targets for maternal, newborn, and child health (MNCH) defined by the Sustainable Development Goals. Barriers at the individual, health system, and contextual levels undermine healthcare access for pregnant women and children, disproportionately affecting those in low-resource settings. To address these challenges in the high-mortality, peri-urban areas of Karachi, VITAL Pakistan Trust and Aga Khan University launched a digital health intervention (DHI) to stimulate demand for health services and streamline care management for health workers at the primary care level. In this case study, we present a narrative review of the design, development, and deployment of the DHI, an Android-based application, in accordance with the Principles for Digital Development. We draw on the initial experience with implementation to reflect on how each of the nine Principles was considered during different phases of the project lifecycle, focusing on the lessons learned and challenges encountered during this process. By engaging with end-users and understanding the community, we were able to map existing relationships and workflows onto a digital platform to address major challenges hindering service delivery. Leveraging insights from field observations and user feedback, we collaborated with experts in healthcare and technology to develop the DHI, which has now scaled to 44 peri-urban settlements in Karachi. Our experience underscores the value of substantiated frameworks like the Principles. However, on-ground challenges reveal important caveats requiring further assessment. These include building community trust in new digital systems and ensuring the ethical use of health data, particularly in low digital and data literacy contexts. Based on this understanding, we share recommendations for conditions central to the effective integration and uptake of technology in healthcare, specifically within the context of digital health for MNCH.

Integrated health reporting within the UN architecture: learning from maternal, newborn and child health

Despite a proliferation of the United Nations General Assembly high-level meetings on a range of health issues and developmental challenges, global funding continues to flow disproportionately to HIV and maternal, newborn and child health (MNCH). Using the experience of MNCH, this short article argues that successful human rights framing and the development of robust and regular reporting mechanisms in the international development architecture has contributed to these areas receiving attention. Taking non-communicable diseases (NCDs) as an example of a relatively neglected health area, we propose mechanisms that would improve integrated reporting of health issues in a way that aligns with the move toward cross-cutting themes and matching political and financial commitments with impact. As new frameworks are being developed to support multi-agency approaches to achieving SDG 3—including reporting and accountability—there are opportunities to ensure MNCH and NCDs jointly seek data collection measures that can support specific targets and indicators that link NCDs with early childhood development.

How to evaluate a multi-country implementation-focused network: Reflections from the Quality of Care Network (QCN) evaluation.

Learning about how to evaluate implementation-focused networks is important as they become more commonly used. This research evaluated the emergence, legitimacy and effectiveness of a multi-country Quality of Care Network (QCN) aiming to improve maternal, newborn and child health (MNCH) outcomes. We examined the QCN global level, national and local level interfaces in four case study countries. This paper presents the evaluation team's reflections on this 3.5 year multi-country, multi-disciplinary project. Specifically, we examine our approach, methodological innovations, lessons learned and recommendations for conducting similar research. We used a reflective methodological approach to draw lessons on our practice while evaluating the QCN. A 'reflections' tool was developed to guide the process, which happened within a period of 2-4 weeks across the different countries. All country research teams held focused 'reflection' meetings to discuss questions in the tool before sharing responses with this paper's lead author. Similarly, the different lead authors of all eight QCN papers convened their writing teams to reflect on the process and share key highlights. These data were thematically analysed and are presented across key themes around the implementation experience including what went well, facilitators and critical methodological adaptations, what can be done better and recommendations for undertaking similar work. Success drivers included the team's global nature, spread across seven countries with members affiliated to nine institutions. It was multi-level in expertise and seniority and highly multidisciplinary including experts in medicine, policy and health systems, implementation research, behavioural sciences and MNCH. Country Advisory Boards provided technical oversight and support. Despite complexities, the team effectively implemented the QCN evaluation. Strong leadership, partnership, communication and coordination were key; as were balancing standardization with in-country adaptation, co-production, flattening hierarchies among study team members and the iterative nature of data collection. Methodological adaptations included leveraging technology which became essential during COVID-19, clear division of roles and responsibilities, and embedding capacity building as both an evaluation process and outcome, and optimizing technology use for team cohesion and quality outputs.

A quasi-experimental study of effects of community health workers’ incentivisation on uptake of maternal, newborn and child health services in Lamu County, Kenya

Background: Community health workers (CHWs) are known as the ‘gate keepers’ of good health in the community. Being the first contact with the patients at the community level, they can help improve the maternal, newborn and child health (MNCH) indicators if they are well motivated to conduct their day-to-day work. At the same time, MNCH indicators are negatively affected by hard-to-reach health facilities and cultural factors thus the CHWs can help improve the health status in this category. Methods: The study utilized a quasi-experimental study design with an intervention and a control site in both Lamu West and Lamu East Sub Counties. Purposive sampling used to select study population and study site. Study period was (August 2018-March 2022). Mixed methods approach was used with both quantitative and qualitative methodologies of data collection to enable data triangulation. Questionnaires were used to collect data from CHWs, focused group discussions with caregivers and In-depth Interviews conducted with key informants from the Ministry of Health- Lamu County and the implementing partner-PharmAccess. Results: The study established that 78% of the CHWs were selected by the community members. Most of the CHWs in the intervention site had attended other trainings after the initial capacity development program, had at least one supervision in the last month preceding evaluation, were satisfied with the community and county appreciation. The difference between control and intervention site had a statistical significance (p&lt;0.05) for report writing during home visits, cross-referencing of reports before submission, attendance of refresher courses, loss of interest to work as a CHW and referral of patients to link facilities. Conclusions: CHWs need motivation in delivering their services. This can be done in form of incentives (both monitory and non-monitory), refresher trainings and supportive supervision.

Developing a group Model of ANC-PNC through human-centered Design (HCD) to Improve MNCH of first-time Mothers (FTMs) in Bangladesh

Objective: First-time parenthood is a complex and emotional journey. The gap between demand and quality services for maternal, newborn and child health (MNCH) and family planning (FP) are significant. Lack of time, awareness, and social support are critical challenges of meeting the service requirement for the young and first-time mothers, especially working mothers in urban areas. Objective of the study was to design an intervention model for the young pregnant women and their partners for improving the quality and use of MNCH and FP services and information. Methods: Using a human-centered design (HCD) approach, we conducted 27 in-depth interviews, 10 focus group discussions, and eight mock sessions with first-time mothers, partners, family members, community influencers and service providers in Tongi, Gazipur. During phase 1, we explored the current realities of life and experience of services, both ideal and existing, from perspectives of a diverse set of stakeholders including both health care providers and care seekers. During phase 2, we designed, tested, and iterated the “group model” of antenatal Care through a series of mock sessions, interviews and consultation with service providers and authorities. We recorded, transcribed, and translated the data for collaborative synthesis and analysis process to generate insight and opportunities for optimizing service delivery and uptake. Results: The study findings spoke for the need of providing group sessions for first time parents, social support from peers and family members and capacity development of the service providers. After careful consideration of the stakeholder needs and preferences, the national guidelines and the local implementing partner’s available resources, we arrived at the recommended group model inclusive of five Group Antenatal Care (GANC) and two group Postnatal Care (GPNC) for mothers. All the pregnant women underwent through clinical checkups by medically trained professionals, mainly midwives and doctors. The group model also includes two GANC and one GPNC for fathers, as well as informative sessions for companions. The prototype model included five GANC and two GPNC sessions for mothers, two GANC and one GPNC session for fathers, and informative sessions for companions. The sessions included pregnant women of close gestational age, use of visual aids to support session facilitation, and activities to support group bonding and information retention. Conclusions: The Group Model offering 5 ANC and 2 PNC for women, 2 GANC and 1 GPNC for male partners, and sessions for caregivers was developed in line with the national and WHO recommendation. This model found a feasible approach that involved partners and caregivers in the process and increased MNCH and social support during the voyage of the pregnancy journey. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(1): 14-23

Unpacking the challenges of fragmentation in community-based maternal newborn and child health and health system in rural Ethiopia: A qualitative study.

In Ethiopia, country-wide community-based primary health programs have been in effect for about two decades. Despite the program's significant contribution to advancing Maternal Newborn and Child Health (MNCH), Ethiopia's maternal and child mortality is still one of the highest in the world. The aim of this manuscript is to critically examine the multifaceted fragmentation challenges of Ethiopia's Community Health Workers (CHWs) program to deliver optimum MNCH and build a resilient community health system. We conducted a qualitative case study in West Shewa Zone, rural Ethiopia. A purposive sampling technique was used to recruit participants. Data sources were two focus group discussions with sixteen CHWs, twelve key informant interviews with multilevel public health policy actors, and a policy document review related to the CHW program to triangulate the findings. Thematic analysis of the qualitative data was conducted. The World Health Organization's health systems framework and socio-ecological model guided the data collection, analysis, and interpretation. The CHWs program has been an extended arm of Ethiopia's primary health system and has contributed to improved health outcomes. However, the program has been facing unique systemic challenges that stem from the fragmentation of health finance; medical and equipment supply; working and living infrastructures; CHWs empowerment and motivation, monitoring, supervision, and information; coordination and governance; and community and stakeholder engagement. The ongoing COVID-19 and volatile political and security issues are exacerbating these fragmentation challenges. This study emphasized the gap between the macro (national) level policy and the challenge during implementation at the micro (district)level. Fragmentation is a blind spot for the community-based health system in rural Ethiopia. We argue that the fragmentation challenges of the community health program are exacerbating the fragility of the health system and fragmentation of MNCH health outcomes. This is a threat to sustain the MNCH outcome gains, the realization of national health goals, and the resilience of the primary health system in rural Ethiopia. We recommend that beyond the current business-as-usual approach, it is important to emphasize an evidence-based and systemic fragmentation monitoring and responsive approach and to better understand the complexity of the community-based health system fragmentation challenges to sustain and achieve better health outcomes. The challenges can be addressed through the adoption of transformative and innovative approaches including capitalizing on multi-stakeholder engagement and health in all policies in the framework of co-production.

Digitalization of home-based records for maternal, newborn, and child health: a scoping review

BackgroundAt least 163 countries use a form of home-based record, a document to record health information kept at home. These are predominantly paper-based, although some countries are digitalizing home-based records for improved access and use. This scoping review aimed to identify efforts already undertaken for the digitalization of home-based records for maternal, newborn, and child health (MNCH) and lessons learned moving forward, by mapping the available peer-reviewed and grey literature.MethodsThe scoping review was guided by Arskey and O’Malley’s framework. A literature search of references published from 2000 until 2021 was conducted in Medline, Embase, CINAHL, EBM reviews, Google Scholar, IEEE Xplore as well as a grey literature search. Title and abstract and full texts were screened in Covidence. A final data extraction sheet was generated in Excel.ResultsThe scoping review includes 107 references that cover 120 unique digital interventions. Most of the included references are peer-reviewed articles in English language published after 2015. Of the 120 unique digital interventions, 80 (66.7%) are used in 31 different countries and 40 (33.3%) are globally available pregnancy applications. Out of the 80 digitalization efforts from countries, most are concentrated in high-income countries (n=68, 85%). Maternal health (n=73; 61%) and child health (n=60; 50%) are the main health domains covered; the main users are pregnant women (n=57; 48%) and parents/caregivers (n=43; 36%).ConclusionsMost digital home-based records for MNCH are centered in high-income countries and revolve around pregnancy applications or portals for home access to health records covering MNCH. Lessons learned indicate that the success of digital home-based records correlates with the usability of the intervention, digital literacy, language skills, ownership of required digital devices, and reliable electricity and internet access. The digitalization of home-based records needs to be considered together with digitizing patient health records.

INVESTIGATING THE EVOLUTION OF OPTIMAL PRODUCT AVAILABILITY FOR PUBLIC HEALTH PROGRAMS IN KATSINA STATE, NIGERIA

Objective: This study aimed to explore the evolution of the availability of public health commodities across all the supported health facilities in Katsina State, northwestern Nigeria. Methods: To achieve this, Quarterly Stock Status Reports (QSSR) were produced from the analysis of the Logistics Management Information System (LMIS) reports of facilities, local government stores, and central stores of all the public health programs in the state from April 2017 to March 2018 (one year). Analyses entailed computing the Month of Stock (MoS) for all commodities by dividing their Stock on Hand (SoH) by the Average Monthly Consumption (AMC). The product availability for the following public health programs was assessed for four consecutive quarters (Apr.-Jun. 2017, Jul.-Sep. 2017, Oct.-Dec. 2017, and Jan.-Mar. 2018)-HIV/AIDS, tuberculosis, malaria, reproductive health/family planning (FP), routine immunization, nutrition, Neglected Tropical Diseases (NTD), Maternal, Newborn, and Child Health (MNCH), and the state’s Free Medicare Scheme (FMS). Results: The one-year trend provided a precise representation of the commodity security of each public health supply chain across various programs within the state. While only one program (routine immunization) recorded 100% all-time product availability, TB appeared to be the most stable (95% of products in optimal quantities) of all the assessed public health programs employing MoS as a performance measure. It is important to note that nutrition, neglected tropical diseases, and the Free Medicare scheme did not operate with MoS as a measure of stock status but recorded product availability of 78.5%, 80%, and 84.6%, respectively. Conclusion: There is a necessity for periodic stock assessment across all public health programs for other states to establish accurate stock positions and identify programs that require enhanced logistical and supply chain technical support.

Association between the quality of care and continuous maternal and child health service utilisation in Angola: Longitudinal data analysis.

Many low- and middle-income countries (LMICs) prioritise minimising maternal, neonatal, and infant mortality. To improve maternal and child health, various evidence-based interventions have been introduced. Quality of care is pertinent while strengthening service utilisations. Achieving optimal-quality care is often marred with difficulties, such as inadequate skills and knowledge of health workers, poor fidelity to protocols, and poor user acceptance. Angola is a LMIC facing these problems. This study aimed to demonstrate the influence of health facilities' quality of care at antenatal care (ANC) on subsequent maternal, newborn and child health (MNCH) service utilisation in Angolan pregnant women. Population-based cohort data from the Maternal and Child Health Handbook (MCH-HB) effectiveness study were analysed. The original study was conducted among women who became pregnant between March and April 2019 in Benguela Province, Angola. Socioeconomic and MNCH service utilisation indicators were collected through interviewer-administered structured questionnaires. The indicator of quality of care was a composite measure that assessed the implementation of the MCH-HB based on the RE-AIM framework, mostly consisted of common factors related to delivery and management of MNCH services. A multivariate logistic regression analysis was performed between quality of care, socioeconomic factors, and service utilisation indicators among the intervention group participants who had at least one ANC visit. Of the 3351 pregnant women who visited ANC at least once, 2911 without missing values among explanatory or dependent variables were included in the analysis. Among them, 2032 (69.8%) were exposed to optimal-quality ANC, and 2058 (70.7%), 1573 (54.0%), and 941 (32.3%) achieved ANC target, facility delivery, and vaccination target for six-month-old infants, respectively. Exposure to suboptimal-quality care at ANC was associated with lower odds for facility delivery (adjusted odds ratio (AOR) = 0.60, 95% CI = 0.49-0.73) and the achievement of the vaccination target (AOR = 0.43, 95% CI = 0.33-0.55). A low socioeconomic status was inversely associated with health service utilisation indicators. Health facilities' quality of care influences subsequent MNCH service utilisation. Therefore, simultaneous efforts to improve quality of care and the mobilisation of pregnant women and communities are essential for enhancing maternal and child health.

Effectiveness of the Gratuité user fee exemption policy on utilization and outcomes of maternal, newborn and child health services in conflict-affected districts of Burkina Faso from 2013 to 2018: a pre-post analysis

BackgroundEvidence on effectiveness of user fee exemption policies targeting maternal, newborn, and child health (MNCH) services is limited for conflict-affected settings. In Burkina Faso, a country that has had its fair share of conflicts, user fee exemption policies have been piloted since 2008 and implemented along with a national government-led user fee reduction policy (‘SONU’: Soins Obstétricaux et Néonataux d'Urgence). In 2016, the government transitioned the entire country to a user fee exemption policy known as Gratuité. Our study objective was to assess the effect of the policy on the utilization and outcomes of MNCH services in conflict-affected districts of Burkina Faso.MethodsWe conducted a quasi-experimental study comparing four conflict-affected districts which had the user fee exemption pilot along with SONU before transitioning to Gratuité (comparator) with four other districts with similar characteristics, which had only SONU before transitioning (intervention). A difference-in-difference approach was initiated using data from 42 months before and 30 months after implementation. Specifically, we compared utilization rates for MNCH services, including antenatal care (ANC), facility delivery, postnatal care (PNC) and consultation for malaria. We reported the coefficient, including a 95% confidence interval (CI), p value, and the parallel trends test.ResultsGratuité led to significant increases in rates of 6th day PNC visits for women (Coeff 0.15; 95% CI 0.01–0.29), new consultations in children < 1 year (Coeff 1.80; 95% CI 1.13–2.47, p < 0.001), new consultations in children 1–4 years (Coeff 0.81; 95% CI 0.50–1.13, p = 0.001), and uncomplicated malaria cases treated in children < 5 years (Coeff 0.59; 95% CI 0.44–0.73, p < 0.001). Other service utilization indicators investigated, including ANC1 and ANC5+ rates, did not show any statistically significant positive upward trend. Also, the rates of facility delivery, 6th hour and 6th week postnatal visits were found to have increased more in intervention areas compared to control areas, but these were not statistically significant.ConclusionsOur study shows that, even in conflict-affected areas, the Gratuité policy significantly influences MNCH service utilization. There is a strong case for continued funding of the user fee exemption policy to ensure that gains are not reversed, especially if the conflict ceases to abate.

Integrating maternal, newborn, child health and non-communicable disease care in the sustainable development goal era.

Noncommunicable diseases (NCDs) and maternal newborn and child health (MNCH) are two deeply intertwined health areas that have been artificially separated by global health policies, resource allocations and programming. Optimal MNCH care can provide a unique opportunity to screen for, prevent and manage early signs of NCDs developing in both the woman and the neonate. This paper considers how NCDs, NCD modifiable risk factors, and NCD metabolic risk factors impact MNCH. We argue that integrated management is essential, but this faces challenges that manifest across all levels of domestic health systems. Progress toward Sustainable Development targets requires joined-up action.

Opportunities and challenges of trilateral South‒South cooperation for transforming development assistance for health: evidence from a DRC–UNICEF–China maternal, newborn, and child health project

BackgroundTrilateral South‒South cooperation is envisioned as an equal and empowering partnership model but still faces certain challenges. This study addresses whether and how trilateral South‒South cooperation can transform traditional development assistance for health (DAH) and explores the opportunities and challenges of trilateral South‒South cooperation for transforming future DAH, in the theme of “the emerging development partner’s DAH transformation facilitated by a multilateral organization”.MethodsWe evaluate a maternal, newborn, and child health (MNCH) project involving the Democratic Republic of Congo (DRC), the United Nations Children’s Fund (UNICEF), and China (hereinafter referred to as the “DRC–UNICEF–China project”). We analyze data from project documents and seventeen semi-structured interviews using a pragmatic analytical framework based on the DAH program logic model and the OECD’s trilateral cooperation framework.ResultsEvidence from the DRC–UNICEF–China MNCH project suggests that trilateral South‒South cooperation facilitated by a multilateral organization can provide transformative opportunities for emerging development partners’ DAH to generate and deliver context-based, demand-oriented solutions, harmonize rules and procedures, institutionalize mutual learning and knowledge sharing, and increase the visibility of emerging development partners as sources for South‒South development experience transfer. However, the project revealed some challenges, including the neglect of key stakeholders in the complex governance structure, the high transaction costs needed to ensure transparency, and the harm local absence of the emerging development partner poses to long-term DAH engagement.ConclusionsThis study echoes some of the findings in trilateral SSC literature that claim power structures and philanthropic, normative justification for health equity are often juxtaposed in trilateral SSC partnerships. The opportunities offered by the DRC–UNICEF–China project align with China’s cognitive learning process for strengthening international engagement and global image building. However, challenges may arise as a result of complex governance structures and the entrustment of facilitating partners, which can threaten the effectiveness of trilateral cooperation. We call for strengthening the beneficiary partner’s ownership at all levels, engaging the emerging development partner to better understand the beneficiary partner’s local context(s) and needs, and ensuring available resources to support programmatic activities and long-term partnerships for the health and well-being of the beneficiaries.

Stakeholder perceptions and experiences from the implementation of the Gratuité user fee exemption policy in Burkina Faso: a qualitative study

BackgroundIn 2016, the Gratuité policy was initiated by the Government of Burkina Faso to remove user fees for maternal, newborn, and child Health (MNCH) services. Since its inception, there has not been any systematic capture of experiences of stakeholders as it relates to the policy. Our objective was to understand the perceptions and experiences of stakeholders regarding the implementation of the Gratuité policy.MethodsWe used key informant interviews (KIIs) and focus group discussions (FGDs) to engage national and sub-national stakeholders in the Centre and Hauts-Bassin regions. Participants included policymakers, civil servants, researchers, non-governmental organizations in charge of monitoring the policy, skilled health personnel, health facility managers, and women who used MNCH services before and after the policy implementation. Topic guides aided sessions, which were audio recorded and transcribed verbatim. A thematic analysis was used for data synthesis.ResultsThere were five key themes emerging. First, majority of stakeholders have a positive perception of the Gratuité policy. Its implementation approach is deemed to have strengths including government leadership, multi-stakeholder involvement, robust internal capacity, and external monitoring. However, collateral shortage of financial and human resources, misuse of services, delays in reimbursement, political instability and health system shocks were highlighted as concerns that compromise the government's objective of achieving universal health coverage (UHC). However, many beneficiaries were satisfied at the point of use of MNHC services, though Gratuité did not always mean free to the service users. Broadly, there was consensus that the Gratuité policy has contributed to improvements in health-seeking behavior, access, and utilization of services, especially for children. However, the reported higher utilization is leading to some perceived increased workload and altered health worker attitude.ConclusionsThere is a general perception that the Gratuité policy is achieving what it set out to do, which is to increase access to care by removing financial barriers. While stakeholders recognized the intention and value of the Gratuité policy, and many beneficiaries were satisfied at the point of use, inefficiencies in its implementation undermines progress. As the country moves towards the goal of realizing UHC, reliable investment in the Gratuité policy is needed.

A Systematic Review and Thematic Synthesis of Qualitative Research Studies on Food Taboos Related to Pregnancy in Ethiopia

Introduction: Pregnancy is a crucial period within newborns' 1000-day nutritional window of opportunity. However, accessing adequate and culturally acceptable foods during this time can be challenging, particularly in developing countries. In Ethiopia, food taboos related to specific foods during pregnancy persist and impact the achievement of maternal, newborn, and child health (MNCH) goals. This systematic review aims to synthesize the evidence on food taboos and their impact on pregnant women in Ethiopia. Methods: A systematic search and thematic analysis of qualitative studies on food taboos and pregnancy in Ethiopia published between 2010 and 2020 were conducted. Eight articles that met the COREQ checklist criteria were retrieved from various databases including PubMed, Scopus, CINAHL, Global Health, and Google Scholar. Results: The included studies revealed a consistent trend of food taboos among pregnant women in Ethiopia. Restricting certain food items was identified as a common practice throughout the country, with a reduction in meal portions and frequency observed as the gestational period progressed. These taboos were based on the perception that excessive weight gain during pregnancy could lead to complications during delivery and that the food consumed by the mother directly impacts the fetus in the womb. Conclusion: The findings of this systematic review highlight the impact of food taboos on pregnant women in Ethiopia. These norms are contrary to mothers encouraged gestational weight gain and can lead to low birth weight. Therefore, a comprehensive approach is needed to change the perception of mothers and influence community members to promote MNCH.